Clinicians

Prescribing the book:

The concepts and materials of our first book, How’s Your Family Really Doing?: 10 Keys to a Happy Loving Family, have been utilized in our counseling agency for years. Couples and families benefit highly from learning about the 10 Keys and practicing the tools for change. As appropriate, we prescribe the book as a part of therapy for a variety of reasons related to its content. Some like to read the whole book and others prefer to focus only on the Keys where they need help. Clients keep the book on hand as a reference and faithful friend to turn to as new challenges or circumstances arise over the years.

Using the Current Family Assessment

Just as with any evaluation instrument, the Current Family Assessment can be handed to clients at any time in the treatment process. Use your clinical judgment to decide the family or client’s readiness. Many clients are motivated to get a copy at the conclusion of the first session. They want to get started on a path toward feedback and change right away.

Explaining the Test

Here’s an example of how we explain the process: “This test will give you a chance to take a few minutes and think about some of the key elements of how you feel your family is doing. Give a score for each of the statements independent of your partner, and when you return we’ll go over your responses. After you see how you score, we can celebrate the areas where you are doing well and focus on the ones where you might need some help.”

Using the Family of Origin Assessment

In Chapter 11 we described using the Family of Origin Assessment as a means of helping parents uncover patterns and compensations from the past that relate to their current struggles. We also prescribe the book and the Family of Origin Assessment to clients in individual therapy who would like to identify and unlearn certain patterns from childhood. Used appropriately, the test highlights and spurs old memories that can be processed in a new way. Clients feel relieved when we normalize their understandable adaptations to “not-so-great” family assessments.

Integrating the 10 Keys into Therapy

In the initial stages of therapy, clients can “present” or complain about a variety of symptoms. We will honor their representation of their problems and address and treat their symptoms directly. Although some clients find a relief from symptoms without ever addressing problems that the Key Assessments uncover, this tends to be the exception rather than the rule. Nevertheless, we share with clients, in a most compassionate way, that they might also want to address the Keys where they are not doing well, – to keep additional future problems from happening. A good analogy of this is when your family physician reads your blood panel and informs you of a cholesterol elevation that you might want to attend to. This process serves to prevent “family” versions of what Freud called “symptom substitution.”

Key Patterns and Combinations

With practice and increased familiarity, the Keys become a new observation lens,- a way to both understand and figure out how to help people. Just as with the MMPI, there are certain patterns of response to the assessment that are characteristic and have distinct implications for treatment. The bottom line is to trust your clinical judgment about how to proceed. There is no specific order that the keys must be addressed in. Nevertheless, we can make the following generalizations:

Effective and efficient therapy can include a focus of support and change on any of a few Key areas of focus within the course of any given session. For example, a portion of a session can be used to help parents to communicate more effectively, and then subsequently focus on setting more effective limits or boundaries through the use of the techniques described in Who’s the Boss?.

The Keys that are most commonly the focus for therapy in our clinic are Keys #1, 2, 5, 6, and 10.

As we emphasized in Chapter 12, if a family scores low on Key #1, Talking and Listening, or on Key #2, Expressing Feelings, these Keys can be a good place to start. They are the foundation for all the rest.

If parents are not on the same page and score poorly on Key #10, an initial focus on this key is also advised. The therapist’s initial challenge is to create a functioning team to be able to accomplish change in the family.

Although addressing Key #2 at the start, try not to get stuck solving all of the emotional challenges in the family if there are also problems with Key #5, Who’s In Charge. Kids who are referred because they are diagnosed as having “anger problems” can look very different when provided sufficient structure and rules. Anger can be reinforced by the fact that there is insufficient family hierarchy.

It is crucial to assess Key #5 when younger children are referred for an assessment of Attention Deficit Disorder with Hyperactivity. Symptoms of ADD often improve when appropriate limits have been established. (Kids can just be bouncing off the walls, looking for limits in all the wrong places.) An interesting parallel occurs when there can be distinct improvement in a child’s ability to concentrate and control the focus of their thinking after parents set healthy limits and boundaries with their behavior.